MetroHealthAnesthesiaPerioperative Medicine and Pain - Medical Student Advanced Core Clerkship

MetroHealthAnesthesia Faculty

Welcome to the Perioperative Medicine rotation. The learning objectives for this four week rotation are ambitious. In order to achieve maximum exposure and benefit, you will need to be independent in meeting daily goals. During your two weeks on the anesthesia service, you will be moving around quite a bit: from pain clinic to PACU, ventilator management to epidurals in laboring women. We hope you enjoy the wide exposure to perioperative medicine.


Pagers: You will be issued a pager for the two week anesthesia elective. It is your responsibility to return the pager in working condition at the end of the rotation.

Learning Objectives:
  1. Describe the role of the consultant and the principles and ethics surrounding medical consultation
  2. Perform and document the complete pre-operative assessment, including: 1) discussion of patient specific risk, surgery specific risk and anesthesia related risk; 2) compare and contrast various options for anesthesia, resulting in a basic anesthesia plan; 3) apply an evidence-based approach to identifying, selecting and interpreting pre-operative laboratory testing; and 4) outline appropriate risk reduction strategies and therapies.
  3. Describe and demonstrate the elements of airway management
  4. Describe the various intraoperative stressors
  5. Demonstrate the ability to interpret hemodynamic monitoring
  6. Apply principles of fluid management and blood resuscitation to the peri-operative period
  7. Evaluate and admit post-operative patients to the post-anesthesia care unit (PACU) and the Intensive Care Unit (ICU)
  8. Demonstrate and understanding of the appropriate utilization and function of the ICU.
  9. Describe the diagnosis and management of common post-op complications such as post-operative MI, pneumonia, VTE, delirium and fever.
  10. Perform a basic assessment of acute post-operative/procedural pain and develop an analgesic plan
  11. Recognize and differentiate between acute, chronic, malignant and non-malignant pain
  12. Describe the principles of safe drug prescribing
Evaluation: You will be given paper forms to hand out to attendings/residents. These are to be returned to Dr. Steele at the end of the rotation so she can formulate a summative grade. Please keep a log of all procedures/anesthetics so we can track your exposure to various techniques.

Schedule for students

You will rotate on the various "services" of the Anesthesia Department. We have at least nine days planned with a tenth day to cover additional areas, special topics or for you to spend an extra day on a particular service you enjoyed.

General Operating room (3 days) - begins at 7am. You should arrive at least at 6:45am to assist the resident. Formulate an anesthetic plan, set up the room and review the patient's chart. Start an IV and appropriate fluids. We also cover ORs at West 150th Ambulatory Surgery Center.

Obstetrical anesthesia (1 day) - 2nd floor Labor & Delivery, Obstetrical Anesthesia office. Arrive no later than 7am. First C/S is typically at 7:30am.

Heart room (1 day) - Check with the resident the night before to assist with room set-up and arrival time. Be familiar with arterial lines, central lines and PA catheter (Swan-Ganz) interpretation before the case.

Pre-Surgical Evaluation (1 day) - Arrange with the PSE resident to meet for post-op checks in the morning. Accompany them to clinic for pre-operative evaluations. In the afternoons, during OR assignments, see patients on the floor with residents who are being evaluated for surgery the next day.

PACU/Acute Pain (1 day) - Check in with charge nurse in the PACU in the morning for your assignment. You will admit and chart on patients during the day. If there are post-op nerve blocks or rounds on acute pain patients, you will accompany and assist the acute pain resident.

Chronic Pain (1 day) - The Pain Management service has two clinical locations: West 150th and on the East Side on Chagrin Blvd. Arrange with the residents on the pain service an appropriate time and place to meet.

Respiratory Care (1 day) - Rounding with a respiratory therapist. They meet at 7am for change-of-shift in their office on the second floor, near the C elevators, just past the PFT lab.

Blood Bank - a presentation on typing and crossing blood products. TBD.

Skills Workshop - one afternoon/month for all students on the rotation. Includes airway management, IV insertion, regional techniques, invasive hemodynamic monitoring.

Greg Gordon MD